Lacrimal Drainage Systems Injured During Repair of Orbital Fractures.

Implant placement for inferomedial orbital fractures through a lower fornix approach requires wide access, with the incision extended in the retrocaruncular line; the lacrimal drainage system is at risk of injury with both the incision and implant. The authors describe the radiologic and surgical findings for 5 patients in whom maxillofacial repair of periorbital fractures was associated with immediate postoperative epiphora; 1 patient also had a fistula between the implant and lower fornix. All patients had marked and early improvement of lacrimal drainage symptoms where uncomplicated open dacryocystorhinostomy or canaliculidacryocystorhinostomy was combined with removal of the offending orbital implants and neighboring screws. All implants were incorrectly positioned (projecting into the ethmoid sinus or inferior orbital fissure) and/or comprised materials of unnecessary size and rigidity for the underlying fracture. Fractures involving the orbital walls (but not rims) can usually be addressed with thin and pliable implants and without screw fixation.